Friday, 10 February 2017

Losing the point

This is part of an extended rant that I may or may not get around to writing, inspired by recent and ongoing medical excitement (not mine).

There's this Grand Concept in the modern health-care system of the Primary Care Physician - your personal gatekeeper doctor who coordinates all of your health care.

Much of the system - basically, everything but emergency / urgent care - is structured around this Concept, to the extent, for example, that in order to get a broken bone set, you need a referral from your PCP, the emergency department's records being insufficient for the purpose. This isn't a huge problem with Kaiser, where I can generally get a same-day appointment with my PCP (my schedule being much more problematic than his), but some other establishments routinely have wait times of a month or more - and this is not a new issue; I recall hearing complaints of unavailable PCPs 20 years ago.

Now, the lost point is this: if you're not using a lot of medical services, chances are your personal gatekeeper is uniquely qualified to attend to your health needs based on meeting with you once a year for five minutes for your annual "exam", which in the Obamacare era basically means confirming that there's a live body still associated with your medical record and asking if you've taken up smoking.

So, really, for many of us, any staff physician with access to our medical records could perform the PCP role every bit as well, on any given occasion, as the designated PCP. But the Holy System insists that There Shall Be A Designated PCP, and that None Other Will Do.

And, if you have a situation that isn't (yet!) an emergency, and that can't be resolved in a 5-minute doc-in-a-box visit? Tough; you'll have to wait for an appointment with your PCP before beginning the process of diagnosis, never mind treatment. Or wait until it is an emergency. Whichever comes first.